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Assessing Leadership and Clinical Performance of Pediatric Emergency Medicine Providers during Level 1 Trauma Resuscitations
Erin B. Henkel, MD, Esther M. Sampayo, MD, MPH, Elizabeth A. Camp, PhD, Bindi Naik-Mathuria, MD, Corrie E. Chumpitazi, MD, David Wesson, MD, Daniel Rubalcava, MD, MSPH. Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.

Background: A modified trauma non-technical skills score (T-NOTECHS) has been described in surgical literature. The utility of this tool has not been explored in pediatrics.

Objective: Assess the utility of the T-NOTECHS tool in the pediatric emergency medicine (PEM) setting and identify barriers to leading an efficient trauma evaluation.

Methods: We conducted a mixed-methods study utilizing video review and semi–structured interviews of PEM team leaders of Level 1 trauma resuscitations at a quaternary children's hospital. Resuscitation videos were scored by five or more reviewers across disciplines: PEM physicians, pediatric surgeons, trauma nurses and advanced practice providers. Median scores were compared using intraclass correlation coefficients (ICC). Selected PEM team leaders completed self-reviews followed by audio-recorded interviews, which were coded and thematic analysis performed.

Results: Twenty-eight trauma resuscitations had complete data from all groups. Median T-NOTECHS score by all providers was 17.3 and PEM self-score was 19.5, with moderate to substantial ICC agreement between all groups (Table 1). Four principal themes emerged as perceived barriers to leading efficient trauma resuscitations: communication between PEM and surgical teams, infrastructure concerns, roles of learners, and lack of standardization across providers.

Conclusions: The T-NOTECHS tool is useful in evaluating PEM leadership during resuscitations with similar scores obtained from experienced reviewers. Systematic interviews of team leaders can identify barriers and means to improve the quality and efficiency of trauma evaluations.

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